Smegma is no more an enigma. Thanks to the work of inquisitive surgeon that nature, formation and role of smegma and its clinical and long-term implications have been clarified. The word smegma is of Greek origin meaning Soap or Salve. The inner prepuce is initially attached to the glans and will undergo a gradual process of separation. Smegma is primarily collection of whitish debris in the subprepucial space which collects if glans and coronal sulcus are not cleaned regularly.

Smegma has characteristic slimy odour, composed of epithelial debris, fat, and proteins. [1] It has mixed bacterial flora with smegum bacillus in 50% of cases. Smegma itself is neither damaging nor irritating substance and as Howe [2] have stated, it is not carcinogenic also.

We report a case of one and ½-year-old child having a diffuse swelling around distal half of penis. He had a narrow prepucial opening and an indentable mobile swelling in the region of glans penis and corona glandis [Figure 1] and [Figure 2]. Gentle dilatation of prepucial opening under general anesthesia revealed presence of dirty white cheesy material, which could be easily scrapped off [Figure 3]. Prepuce could be easily retracted and slide back over glans thereafter.

Dr. Salle reported a case of a 5 year child in whom balanoprepucial adhesions led to trapping of significant amount of smegma leading to formation of a whitish cyst around corona. [3] In some cases these cysts can undergo bacterial superinfection. These collection of smegma are sometimes mistaken for abnormal growth by parents and medical practitioners requiring surgical excision, which is really not necessary. [4] Sometimes these collections of smegma start coming out through the preputial opening as white sticky material, which some mistake for purulent material coming through the urethra due to a urinary tract infection. However, in both above mentioned conditions all that needs to be done is reassurance for natural separation to take place over time. [4]

A belief held for centuries that origin of smegma from Tyson's gland [5] is not corroborated by acceptable evidence to indicate whether such glands even exist [1] but Kar [6] and Eisen [7] belive presence of Tyson's gland.

Subprepucial space is kept moist and also clear in those with prepucial stenosis by the secretions of the prostate and seminal vesicle and mucin content of secretion of urethral glands. [8] Smegma only collects when there are associated subprepucial adhesions as in phimosis. [8] In the context of subprepucial smegma collection two terminologies, i.e., Smegma Pearl and prepucial cyst needs to be differentiated. Smegma Pearl is subprepucial collection of smegma between foreskin and glans while prepucial cyst arises from preucial skin and therefore it is also called as Keratin Pearl. [9] Our case will fall in category of Smegma Pearl.